Abstract
Assessing the Scalability of a Cancer Screening Patient Navigation Intervention Using RE-AIM
Amy DeGroff, PhD, MPH1, LIndsay Gressard, MPH, MEd1, Ketra Rice, PhD1, Rebecca Glover-Kudon, Ph.D.1, Janene Robie, MBA2, Joanne Gersten, RN2, Lynn Butterly, MD3 and Cam Escoffery, PhD4
(1)Centers for Disease Control and Prevention, Atlanta, GA, (2)New Hampshire Colorectal Cancer Control Program, Lebanon, NH, (3)New Hampshire Colorectal Cancer Screening Program, Lebanon, NH, (4)Rollins School of Public Health, Emory University, Atlanta, GA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
background: Only 65.7% of U.S. adults were up-to-date with colorectal cancer (CRC) screening in 2014 and disparities exist based on ethnicity, income, and education. Patient navigation (PN), a strategy that decreases barriers to care, reduces health disparities and increases cancer screening. We evaluated the effectiveness of a PN intervention in New Hampshire and found 96.2% of navigated patients completed colonoscopy compared to 69.3% among a control group (p <.001). This study evaluates implementation of the intervention to assess the potential for dissemination.
methods: We conducted a mixed-methods evaluation including a comparison group study and a case study (interviews with 29 stakeholders, implementation data for 443 navigated clients, extensive document review, 16 hours of navigator observations). We applied the 5 dimensions of the RE-AIM framework to evaluate implementation: Reach, Efficacy, Adoption, Implementation, and Maintenance.
results: Intervention reach reached 2000 people statewide; the 433 study clients included both men and women with 20.3% non-English speakers. Efficacy/effectiveness was previously established. All 12 endoscopy sites invited to participate agreed, reflecting a high level of adoption. Adoption was aided by a program champion. Implementation fidelity was high with 82% receiving the full protocol which requires 6-contacts. On average, patients received 82.5 minutes of direct contact over a period of 66.0 days. Maintenance was supported by strong management, low staff turnover, a highly functioning PN database, and implementation documents.
conclusion: In public health, disseminating evidence-based practice helps achieve positive outcomes and ensures efficient use of resources. Our results suggest this PN intervention can be successfully scaled.
Chronic disease management and prevention Conduct evaluation related to programs, research, and other areas of practice Diversity and culture Implementation of health education strategies, interventions and programs Public health or related nursing Public health or related research
Abstract
Differences in Cervical Cancer Screening by Geographical Birth Place
Christian Geneus, MS, MPH1, Nosayaba Osazuwa-Peters, PhD, BDS, MPH, CHES2, Eric Adjei Boakye, MA, PhD2, Kahee Mohammed, MD, MPH3 and Betelihem Tobo, MPH, PhD(c)4
(1)Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, (2)Saint Louis University, Saint Louis, MO, (3)Saint Louis University, St. Louis, MO, (4)Saint Louis University College for Public Health and Social Justice, St. Louis, MO
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
OBJECTIVES With the well-known disparities in access to healthcare among foreign-born individuals, this study aimed to investigate variations in cervical cancer screenings(Pap smear) based on geographical birth place, using a nationally representative sample.
METHODS Using Data from the 2014 National Health Interview Survey (NHIS), analysis was conducted on 9,415 survey participants, aged ≥18 years. Weighted, adjusted multivariable logistic regression model was used to assess whether birth place would be indicative of differences in the likelihood of cervical cancer screening.
RESULTS Within study sample, the estimated probability of Pap smear or test was 53.91%. After adjusting for sociodemographic determinants, we noted differences by geographical birth place. Compared to US-born women, women born in Central or Latin America had higher odds of receiving a Pap smear (aOR: 1.30; 95% CI: 1.07-1.58); while those born in Asia had significantly lower odds of receiving a Pap smear (aOR = 0.62; 95% CI: 0.52-0.94). Other predictors of receiving a Pap smear or test were: age; women aged 21-34 years had 2.58 (95% CI: 2.16-3.08) and women aged 35-44 years had 1.30 (95% CI: 1.11-1.53) higher odds of receiving a Pap smear or test compared to older women (aged 55-64 year).
CONCLUSION Variations in cervical cancer screening practices exist among women in the United States. As the leading cause of cancer death among women from most of the developing countries from where many of the foreign-born US women migrated, it is important that interventions are designed to optimize use of prevention cancer services among these women.
Chronic disease management and prevention Epidemiology
Abstract
National Profile of Colorectal (CRC) Screening Among Patients Served by Federally Funded Health Centers
Sue Chienshy Lin, PhD MS and Laura Makaroff, DO
U.S. Department of Health and Human Services, Health Resources and Services Administration, Rockville, MD
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Colorectal cancer (CRC) remains the second-leading cause of cancer-related death in the United States. Screening and early detection of CRC has been shown to save lives. However, national CRC screening rates remain low with persistent disparities among high-risk groups including but not limited to older adults, women, African American, personal and family history, and lifestyle factors. Federally funded Health Center are tasked with increasing access to comprehensive primary care services including CRC screening for vulnerable and underserved populations. The primary study objective is to describe the sociodemographic profile of receipt of CRC screening among Health Center patients.
Methods: The analytic sample population is comprised of adults age 50-75 who completed the 2014 Health Center Patient Survey, a nationally representative sample of patients served by federally funded health centers (N=2661). We conducted bivariate analysis and multivariate logistic regressions to examine sociodemographic factors associated CRC screening among patients served at Health Center. All analysis was performed with SAS, version 9.4.
Results: 66% of Medicaid beneficiaries and 69% of individuals with other insurance served at the Health Center received CRC screening. Among individuals age 50-64, 52% received CRC screening as compared to 80% for individuals age 65-75. No statistical significant differences were observed among gender, race, and educational attainment categories.
Conclusions: The high quality of and equitable access to preventive and primary health care provided at federally funded Health Centers have addressed areas of sociodemographic disparities in age, race/ethnicity, insurance status, and educational attainment for CRC screening.
Administration, management, leadership Planning of health education strategies, interventions, and programs Provision of health care to the public
Abstract
Impact of ACA's Medicaid expansion on client demographics and breast health behaviors for medically underserved women through the Avon Breast Health Outreach Program
Karin Bauer, MS, MA, Lindsay Senter, MPH and Kathryn Gates-Ferris, MS, MPA, CHt
CAI Global, New York, NY
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background
The Avon Breast Health Outreach Program (BHOP) supports community-based organizations to conduct outreach and education to navigate low-income and uninsured/underinsured women to breast cancer screening and care. Through the Affordable Care Act (ACA), some states have expanded Medicaid coverage impacting demographics and breast health behaviors of BHOP clients.
Methods
Confidential client intake records of continuously-funded BHOP grantees were analyzed; including females aged 40-64, recruited for breast cancer screening. Records from four select states were compared: 19,598 from expansion states (California, New York) versus 5,523 clients from non-expansion (Texas, Virginia).
Results
Expansion states experienced a greater decrease in the proportion of uninsured clients (-15.3%) compared to non-expansion (-11.7%). Clients with less than high school education increased in expansion (4.3%) and not non-expansion (0.9%). In expansion states, black and Hispanic clients increased 3.5% and 5.5% and white decreased 2.3%, whereas proportions remained steady in non-expansion. Foreign-born clients increased in both expansion (2.2%) and non-expansion (1.7%) states. The proportion of women who reported a mammogram in the past 2 years increased 4.2% in expansion states, but decreased 8.4% in non-expansion.
Conclusions
Unsurprisingly, expansion states saw a higher proportion of insured women following ACA than non-expansion. Expansion states also experienced a higher proportion of clients reporting a recent mammogram than non-expansion, which is likely not due to the healthy immigrant effect as the proportion of foreign-born clients increased in both. BHOP programs should be aware of shifting client demographics and breast health behaviors as a result Medicaid expansion, including increased demand for services.
Implementation of health education strategies, interventions and programs Public health or related public policy Public health or related research
Abstract
Introducing a new cancer registry-survey data linkage to measure patient experience: SEER-CAHPS
Lisa Lines, PhD, MPH1, Michael Halpern, MD, PhD2, Matthew Urato, MA3, Julia Cohen, MA1, Nicola Schussler, BS4, Sarah Gaillot, PhD5 and Erin E. Kent, PhD6
(1)RTI International, Waltham, MA, (2)RTI International, Durham, NC, (3)RTI International, Research Triangle Park, NC, (4)IMS, Rockville, MD, (5)Centers for Medicare & Medicaid Services, Baltimore, MD, (6)National Cancer Institute, Rockville, MD
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Limited opportunities exist to conduct large-scale, population-based surveillance of cancer patient-reported outcome data. The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) data have recently been linked with data from the Centers for Medicare & Medicaid Services-sponsored Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) surveys. SEER-CAHPS links clinical, sociodemographic, and geographic data from cancer registries (SEER) with Medicare eligibility data, and with cross-sectional MCAHPS survey data, for both fee-for-service (FFS) and Medicare Advantage (MA) enrollees. The MCAHPS surveys collect data on multiple aspects of experiences with care, including access to needed and timely care, physician communication, health plan customer service, ease of getting prescription medication, and care coordination. The current dataset includes individuals with a SEER-reported cancer diagnosis (n=205,339) or with no cancer history (n=723,496) who completed a CAHPS survey between 1998 and 2013. Medicare claims are available for FFS beneficiaries (~40% of total sample). Common cancer sites include breast (19%), colorectal (11%), lung (9%), and prostate (20%). About 14% of MA and 16% of FFS beneficiaries with cancer completed a CAHPS survey within 2 years of receiving their first cancer diagnosis. Individuals in the cancer cohort were more likely to report fair/poor health if they were enrolled in FFS Medicare (34%) than if they were in MA (29%). SEER-CAHPS provides population-based patient-reported data, allowing unprecedented opportunities to evaluate the experiences of cancer patients on a national scale. Researchers can apply for access beginning in late 2016.
Epidemiology Provision of health care to the public Public health or related research
Abstract
Mississippi Cancer Hospitalizations: Economic Burden, Demographics, and Outcomes
Manuela Staneva, MPH, Christianne Pinell-Jansen, MPH and Lei Zhang, PhD, MSc, MBA
Mississippi State Department of Health, Jackson, MS
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Currently, cancer is associated not only with increased survival rates, but also with escalating healthcare costs. Healthcare data present a cost-effective and evidence-based way to study these cancer-related healthcare expenditures. In this study, we used Mississippi hospital discharge data for 2010-11 to evaluate the economic burden, demographics, and in-hospital mortality of the state's cancer-related hospitalizations.
Methods: We selected discharges with malignant neoplasms as a primary diagnosis and conducted comparative analyses of cancer and non-cancer hospitalizations using Chi-square tests and t-tests. Data were analyzed with SAS 9.2.
Results: There were 16,156 cancer hospitalizations in Mississippi during 2010-11. The hospitalized cancer patients in this period were more likely to be males (50.9% vs. 40.2%, p <.001), older (64.3 years vs. 49.9 years, p < .001), and Caucasian (62.0% vs. 59.0%, p < .001) than all other hospitalized patients. Cancer hospitalizations were associated with longer mean length of stay (6.9 days vs. 5.4 days, p < .001), higher mean hospitalization charges ($45,601.3 vs. $25,864.1, p < .001), and higher in-hospital mortality rate (7.2% vs. 2.2%, p < .001) compared to all other hospitalizations. The total charges reached $736,734,102 and the total patient days were 111,989 days.
The leading cancer hospitalizations were for colorectal (17.8%), lung (17.8%), breast (10.9%), prostate (8.6%), and kidney cancer (4.8%). The highest mean charges were for leukemia ($82,737), non-Hodgkin lymphoma ($66,325), and stomach cancer ($65,744).
Conclusion: This study demonstrates that cancer hospitalizations are costly and underscores the value of hospital discharge data for assessing and monitoring healthcare expenditure and outcomes.
Clinical medicine applied in public health Epidemiology Planning of health education strategies, interventions, and programs Provision of health care to the public Public health or related research
Abstract
Multi-level evidence-based colorectal cancer screening interventions: A systematic review of the literature
Coralia Vazquez-Otero, JD, MPH, CPH1, Belinda-Rose Young, MSPH, CPH2, Aldenise Ewing, MPH1, Laura Baum, MPH, MA, CPH2, Claudia Aguado Loi, PhD, MPH, CHES2, Dinorah Martinez Tyson, PhD, MPH, MA2, Cathy Meade, PhD, RN, FAAN3, Carol A. Bryant, PhD2 and Clement Gwede, PhD, MPH, RN, FAAN3
(1)University of South Florida, College of Public Health, Tampa, FL, (2)University of South Florida, Tampa, FL, (3)Moffitt Cancer Center and Morsani College of Medicine, University of South Florida, Tampa, FL
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Introduction: Despite decreases in incidence and mortality as a result of effective screening tests; colorectal cancer screening (CRCS) tests remain underutilized in the U.S. Interventions aiming to increase CRCS uptake vary with respect to strategies used. The objective of this systematic review was to synthesize evidence on the effectiveness of multi-level CRCS interventions.
Methods: The search included five databases. Randomized controlled trials (RCTs) of CRCS interventions were included if conducted in the U.S. and published during August 1/2009 to December 31/2014.
Results: Our search identified 4, 086 articles that were screened for eligibility. Of the 101 studies eligible for this review, 51 described RCTs. RCTs were classified either as client-directed, provider-directed, system-directed, or “combination” of at least two of these levels. Twelve studies included multi-level interventions, most (n=8) combined client and provider-directed strategies. Other combinations included: provider/system (n=2); client/system (n=1); and client/provider/system (n=1). When compared to usual care, intervention conditions involving client and provider reminders, coupled with educational information, patient navigation and removal of access barriers demonstrated the greatest effectiveness. However, among studies with significant impact on screening, effects varied with uptake in the range of 21.5%-71.2% for innovative arms compared to 9%-62.8% in comparison conditions.
Conclusions: Multi-level evidence-based interventions that integrate patient- and provider-directed components improve CRC uptake but there is still room for improvement. The addition of systematic changes at the health system level may also have added value to increasing screening. Future CRCS interventions should incorporate two or more levels of intervention to achieve better screening uptake.
Administer health education strategies, interventions and programs Public health or related research Social and behavioral sciences
Abstract
Racial and Ethnic Disparities in Mammography Utilization Among Women With Intellectual Disabilities
Evelyn Arana, MS, DrPH
Hackensack University Medical Center, Hackensack, NJ
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Women with intellectual disabilities (ID) have lower rates of mammography receipt compared to women without ID and are diagnosed with breast cancer at later stages. Among this population, the perceptions among different racial/ethnic groups surrounding mammography utilization are unknown. This study explores disparities in mammography utilization among women with ID. Results from this research can be considered when planning breast cancer prevention interventions and may be used to enhance the quality of healthcare for this population.
Quantitative Phase: 42 African American, 29 White women, and 14 Hispanic women with ID were recruited. Covariates include race/ethnicity and living situation and the dependent variable is mammogram receipt from 2010 – 2013. Chi-square tests were run in SPSS to analyze variable relationships. Logistic regression results are underway.
Qualitative Phase: 12 African American, 7 White, and 7 Hispanic women were interviewed to determine the barriers and facilitators to mammogram receipt. Interviews will be analyzed via grounded theory and thematic saturation using Atlas.ti.
Results: Preliminary findings show that women with ID who live in regulated housing are more likely to have a mammogram done across all years (p=0.047) than if they live at home with family. However, there are no differences in mammogram receipt across racial/ethnic groups of women with ID (p=0.720). Qualitative interview analysis is currently underway will be finalized in time for this conference.
This research combines quantitative and qualitative methodologies among a priority population. In the long-term, the results from this research may improve the delivery of improved healthcare to this population.
Assessment of individual and community needs for health education Other professions or practice related to public health Provision of health care to the public Public health or related education Public health or related research Social and behavioral sciences
Abstract
Fatalistic cancer beliefs and cancer health behaviors in formerly incarcerated racial and ethnic minority men
Pamela Valera, PhD, ACSW1, Laura Brotzman, MPH2 and Zi Lian, MPH3
(1)Columbia University, New York, NY, (2)Columbia University Mailman School of Public Health, New York, NY, (3)Teachers College, Columbia University, New York, NY
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Introduction.
Racial and ethnic minority men are disproportionately affected by cancer, and have the highest rates of morbidity and mortality. These challenges are magnified for the substantial population of men who have been incarcerated, and whose access to health care has been compromised.
Methods.
A survey assessing demographics, incarceration experience, psycho-social, behavioral, and cancer health information was administered to 230 previously incarcerated men aged 35 years and older. Data analysis was performed to assess the association between each fatalistic belief and health status, demographics, information-seeking pattern, and cancer screening. In addition, we used binary logistic regression models to examine each variable as a predictor of agreeing with fatalistic beliefs and a multi-variable logistic regression model to assess fatalistic beliefs and cancer cognition as predictors of cancer screening.
Results.
This study reveals three important findings. First, the majority of the participants (68.7%) held the fatalistic belief: “When I think of cancer, I automatically think of death”. Second, the fatalistic belief (“There's not much you can do to lower your chances of getting cancer”) is more prevalent among those who perceived higher risk of developing cancer. Third, participants who had not undergone any cancer screening (64.35%) were more likely to hold fatalistic beliefs.
Discussion.
Findings suggest cancer screening and information seeking improve cancer risk perception and reduce fatalistic cancer beliefs. Ultimately, incorporating cancer prevention education has the potential to reduce cancer risk and improve cancer health outcomes for thousands of ethnic and minority men across the criminal justice system.
Assessment of individual and community needs for health education Diversity and culture Planning of health education strategies, interventions, and programs Public health or related research
Abstract
Investigating System Level Approaches to Increasing Colorectal Cancer Screening Rates
Anne Abbott, MPP
University of Iowa, Iowa City, IA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Disparities in colorectal cancer (CRC) mortality by race, income, and gender suggest a need for interventions targeted at improving access to screening services for disparate populations. Federally Qualified Health Centers (FQHCs) in Iowa have partnered with the Iowa Department of Public Health (IDPH), the Iowa Primary Care Association and the American Cancer Society to implement system-level approaches to improve CRC screening rates. FQHCs engage in this work through one of two approaches. The first approach focuses on increasing the use of evidence-based interventions (EBIs) to raise screening rates among Iowa's primarily underserved, underinsured and/or uninsured populations across the state. The second approach provides professional development for health care providers as a mechanism for increasing provider recommendations for screening to all age-eligible men and women in the state.
Results from a survey of participating FQHCs, key informant interviews with IDPH and FQHC partner organizations and pre- and post-intervention screening data will be presented. Process findings about recruitment of, and collaboration with FQHCs, barriers and facilitators to building cross-sector partnerships to achieve better outcomes and tracking data effectively will also be discussed.
Systems-level approaches increase access to CRC screening as well as other cancer screening efforts. Public health practitioners must better understand the implementation of these efforts to increase screening rates and the number of cancers caught early in disparate populations.
Implementation of health education strategies, interventions and programs Public health or related research